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Stone A, Donohue CM. Diabetic Foot Ulcers in Geriatric Patients. Clin Geriatr Med 2024; 40:437-447. [PMID: 38960535 DOI: 10.1016/j.cger.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Care for the patient with diabetic foot ulcers (DFUs) entails understanding the epidemiology, pathophysiology, and a systematic approach to diagnosis and treatment. The authors will review elements of DFU in geriatric patients including the pathophysiology of diabetes, epidemiology and management of DFU in the context of developing a Plan for Healing. The authors will discuss comprehensive principles of a Plan for Healing, which applies to all aspects of chronic wounds.
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Affiliation(s)
- Arthur Stone
- MedNexus, Inc., 1 Applewood Drive, Greenville, SC 29615, USA.
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2
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Abstract
The term 'diabetic foot disease' (DFD) often signifies the presence of foot ulceration and infection, but one must also be wary of the rarer occurrence of Charcot foot disease. The worldwide prevalence of DFD is 6.3% (95%CI: 5.4-7.3%). Foot complications present a major challenge to both patients and healthcare systems, with increased rates of hospitalisation and an almost trebled 5-year mortality. The Charcot foot often occurs in patients with long-standing diabetes, presenting as an inflamed or swollen foot or ankle, following unrecognised minor trauma. This review focuses on the prevention and early identification of the 'at-risk' foot. DFD is best managed by a multi-disciplinary foot clinic team consisting of podiatrists and healthcare professionals. This ensures a combination of expertise and provision of a multi-faceted evidence-based treatment plan. Current research using endothelial progenitor cells (EPC) and mesenchymal stem cells (MSC) offers a new dimension in wound management.
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Affiliation(s)
| | | | - David V Coppini
- University Hospitals Dorset NHS Trust, Dorset, UK, and visiting fellow, Bournemouth University, Bournemouth, UK
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Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr 2023; 15:55. [PMID: 36945043 PMCID: PMC10031885 DOI: 10.1186/s13098-023-01032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. MAIN BODY Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. CONCLUSIONS Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.
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Apergi K, Dimosthenopoulos C, Papanas N. The Role of Nutrients and Diet Characteristics in the Management of Diabetic Foot Ulcers: A Systematic Review. INT J LOW EXTR WOUND 2023:15347346231153531. [PMID: 36734085 DOI: 10.1177/15347346231153531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Diabetic foot ulcers (DFUs) are common complications of diabetes mellitus that affect patients' quality of life and pose a burden on the healthcare system. Although malnutrition and specific nutritional deficiencies can seriously impact wound healing in patients with chronic nonhealing wounds, the role of nutrition in the prevention and management of DFUs is still not clear. This review discusses the significance of frequent diet assessment and nutritional education of patients with DFUs with individualized correction of deficiencies and emphasis on adequate protein intake along with correction of vitamins D, C, E, and selenium status. Future research should clarify the impact of nutritional interventions, potentially involving the use of probiotics, zinc, and omega-3 fatty acids, and successfully translating the findings into practical guidelines for use in everyday clinical practice.
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Affiliation(s)
- Kyriaki Apergi
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
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Li Y, Li X, Ju S, Li W, Zhou S, Wang G, Cai Y, Dong Z. Role of M1 macrophages in diabetic foot ulcers and related immune regulatory mechanisms. Front Pharmacol 2023; 13:1098041. [PMID: 36699091 PMCID: PMC9868553 DOI: 10.3389/fphar.2022.1098041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives: Diabetes foot ulcers (DFUs) are characterized by immune infiltration of M1 macrophages observed in foot skin, in which immune-associated genes (IRGs) play a prominent role. The precise expression of IRGs as well as any possible regulatory mechanisms that could be present in DFUs is yet unknown. Methods: The sequencing data of single-cell RNA (scRNA) in the foot skin of patients with DFUs were analyzed, screening out the cluster marker genes of foot skin obtained from the ImmPort database. IRG activity was assessed with the AUCell software package. The IRGs of DFUs were explored by analyzing the batch sequencing dataset of DFU skin tissue. HumanTFDB was adopted to identify relevant regulatory transcription factors (TFs). The STRING dataset was used to build the main TF protein-protein interaction networks. WB and immunofluorescence methods were used to verify M1 macrophage-related immune regulators. Results: There were 16 clusters found: SMC1, fibro, t-lympho, he fibro, vasendo, baselkera, diffkera, SMC2, M1 macro, M2 macro, sweet/seba, B-Lympho, Melanio, lymphendo, plasma, and Schwann. M1 and M2 macrophages both had considerably higher AUC ratings than patients with DFUs compared to other sub-populations of cells. The proportion of M1 macrophages was the highest in the non-healing group. According to scRNA analysis and batch sequencing data by GO and KEGG, DEGs were enriched in immune response. Some 106 M1 macro-IRGs were finally identified and 25 transcription factors were revealed as associated with IRG expression. The PPI network indicated NFE2L2, REL, ETV6, MAF, and NF1B as central transcription factors. Conclusion: Based on the bio-informatics analysis of scRNA and high-throughput sequencing data, we concluded that M1 macrophages may serve as the influencing factor of DFUs' non-union. In addition, NFE2L2 could be involved in the regulation of IRG expression within M1 macrophages.
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Affiliation(s)
- Yao Li
- Jinshan Hospital, Fudan University, Shanghai, China,Zhongshan Diabetic foot Multidisciplinary Diagnosis and Treatment Center and Jinshan Operation Center, Shanghai, China
| | - Xiaoyan Li
- Jinshan Hospital, Fudan University, Shanghai, China,Zhongshan Diabetic foot Multidisciplinary Diagnosis and Treatment Center and Jinshan Operation Center, Shanghai, China
| | - Shuai Ju
- Jinshan Hospital, Fudan University, Shanghai, China,Zhongshan Diabetic foot Multidisciplinary Diagnosis and Treatment Center and Jinshan Operation Center, Shanghai, China
| | - Wenqiang Li
- Jinshan Hospital, Fudan University, Shanghai, China,Zhongshan Diabetic foot Multidisciplinary Diagnosis and Treatment Center and Jinshan Operation Center, Shanghai, China
| | - Siyuan Zhou
- Jinshan Hospital, Fudan University, Shanghai, China,Zhongshan Diabetic foot Multidisciplinary Diagnosis and Treatment Center and Jinshan Operation Center, Shanghai, China,Shanghai Medical College, Fudan University, Shanghai, China
| | - Guili Wang
- Jinshan Hospital, Fudan University, Shanghai, China,Zhongshan Diabetic foot Multidisciplinary Diagnosis and Treatment Center and Jinshan Operation Center, Shanghai, China,Shanghai Medical College, Fudan University, Shanghai, China
| | - Yunmin Cai
- Jinshan Hospital, Fudan University, Shanghai, China,Zhongshan Diabetic foot Multidisciplinary Diagnosis and Treatment Center and Jinshan Operation Center, Shanghai, China
| | - Zhihui Dong
- Jinshan Hospital, Fudan University, Shanghai, China,Zhongshan Diabetic foot Multidisciplinary Diagnosis and Treatment Center and Jinshan Operation Center, Shanghai, China,Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Zhihui Dong,
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Huang F, Lu X, Yang Y, Yang Y, Li Y, Kuai L, Li B, Dong H, Shi J. Microenvironment-Based Diabetic Foot Ulcer Nanomedicine. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2203308. [PMID: 36424137 PMCID: PMC9839871 DOI: 10.1002/advs.202203308] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/02/2022] [Indexed: 06/04/2023]
Abstract
Diabetic foot ulcers (DFU), one of the most serious complications of diabetes, are essentially chronic, nonhealing wounds caused by diabetic neuropathy, vascular disease, and bacterial infection. Given its pathogenesis, the DFU microenvironment is rather complicated and characterized by hyperglycemia, ischemia, hypoxia, hyperinflammation, and persistent infection. However, the current clinical therapies for DFU are dissatisfactory, which drives researchers to turn attention to advanced nanotechnology to address DFU therapeutic bottlenecks. In the last decade, a large number of multifunctional nanosystems based on the microenvironment of DFU have been developed with positive effects in DFU therapy, forming a novel concept of "DFU nanomedicine". However, a systematic overview of DFU nanomedicine is still unavailable in the literature. This review summarizes the microenvironmental characteristics of DFU, presents the main progress of wound healing, and summaries the state-of-the-art therapeutic strategies for DFU. Furthermore, the main challenges and future perspectives in this field are discussed and prospected, aiming to fuel and foster the development of DFU nanomedicines successfully.
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Affiliation(s)
- Fang Huang
- Key Laboratory of Spine and Spinal Cord Injury Repair and RegenerationMinistry of EducationTongji HospitalSchool of MedicineTongji University389 Xincun RoadShanghai200065China
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of Ceramics Chinese Academy of Sciences; Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050China
| | - Xiangyu Lu
- Shanghai Tenth People's HospitalShanghai Frontiers Science Center of Nanocatalytic MedicineThe Institute for Biomedical Engineering and Nano ScienceSchool of MedicineTongji UniversityShanghai200092China
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of Ceramics Chinese Academy of Sciences; Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050China
- Shanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghai200443China
| | - Yan Yang
- Key Laboratory of Spine and Spinal Cord Injury Repair and RegenerationMinistry of EducationTongji HospitalSchool of MedicineTongji University389 Xincun RoadShanghai200065China
| | - Yushan Yang
- Key Laboratory of Spine and Spinal Cord Injury Repair and RegenerationMinistry of EducationTongji HospitalSchool of MedicineTongji University389 Xincun RoadShanghai200065China
| | - Yongyong Li
- Shanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghai200443China
| | - Le Kuai
- Department of DermatologyYueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghai200437China
| | - Bin Li
- Shanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghai200443China
- Department of DermatologyYueyang Hospital of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghai200437China
| | - Haiqing Dong
- Key Laboratory of Spine and Spinal Cord Injury Repair and RegenerationMinistry of EducationTongji HospitalSchool of MedicineTongji University389 Xincun RoadShanghai200065China
| | - Jianlin Shi
- Shanghai Tenth People's HospitalShanghai Frontiers Science Center of Nanocatalytic MedicineThe Institute for Biomedical Engineering and Nano ScienceSchool of MedicineTongji UniversityShanghai200092China
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of Ceramics Chinese Academy of Sciences; Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050China
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Chen SM, (Jo) Wu CJ. Investigating the effects of digital foot self-management program on enhancing self-efficacy and self-care behavior among community-dwelling older adults with type 2 diabetes: A randomized controlled trial. Digit Health 2023; 9:20552076231220791. [PMID: 38107978 PMCID: PMC10722916 DOI: 10.1177/20552076231220791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Diabetic foot self-management intervention programs have been proven to positively influence individuals' behaviors in preventing diabetic foot ulcers. Using digital technologies to deliver programs can facilitate compliance with diabetes self-management programs. However, few studies have focused on the effects of such digital programs on improving the self-efficacy and behaviors of older adults with type 2 diabetes in the community. Aim To evaluate the effects of a digital foot self-management program on self-efficacy, self-care behavior, and Hemoglobin A1c levels. Design A single-blinded, randomized controlled trial was conducted. Methods The intervention program comprised a 4-week digital foot care program with one face-to-face education session, phone calls once weekly, and LINE messages (social media) three times per research nurse and a follow-up of three months. Patients in the control group received routine care. Results A total of 100 participants (n = 50 in the control and n = 50 in the intervention groups) completed the study with a mean age of 67.55 (SD = 11.17). The results showed significant improvements in self-efficacy (F = 2187.24, p < 0.01) and self-care behavior (F = 614.71, p < 0.01) in foot care between the groups. The Hemoglobin A1c levels showed a 0.41% reduction over time in the experimental group (t = -3.759; p < 0.01), whereas the control group showed a 0.06% reduction (t = -0.797, p > 0.05). Conclusion The newly developed digital foot self-management program was effective in community-dwelling older adult patients with type 2 diabetes.
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Affiliation(s)
- Shu-Ming Chen
- Deputy Dean, School of Nursing, Fooyin University, Taiwan
| | - Chiung-Jung (Jo) Wu
- School of Health, University of the Sunshine Coast, Australia
- Royal Brisbane and Women's Hospital, Australia
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Yang L, Rong GC, Wu QN. Diabetic foot ulcer: Challenges and future. World J Diabetes 2022; 13:1014-1034. [PMID: 36578870 PMCID: PMC9791573 DOI: 10.4239/wjd.v13.i12.1014] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulcers (DFUs) have become one of the important causes of mortality and morbidity in patients with diabetes, and they are also a common cause of hospitalization, which places a heavy burden on patients and society. The prevention and treatment of DFUs requires multidisciplinary management. By controlling various risk factors, such as blood glucose levels, blood pressure, lipid levels and smoking cessation, local management of DFUs should be strengthened, such as debridement, dressing, revascularization, stem cell decompression and oxygen therapy. If necessary, systemic anti-infection treatment should be administered. We reviewed the progress in the clinical practice of treating DFUs in recent years, such as revascularization, wound repair, offloading, stem cell transplantation, and anti-infection treatment. We also summarized and prospectively analyzed some new technologies and measurements used in the treatment of DFUs and noted the future challenges and directions for the development of DFU treatments.
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Affiliation(s)
- Li Yang
- Department of Endocrinology, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China
| | - Gui-Chuan Rong
- Department of Gynaecology, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China
| | - Qi-Nan Wu
- Department of Endocrinology, Dazu Hospital of Chongqing Medical University, The People's Hospital of Dazu, Chongqing 402360, China
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Da Porto A, Miranda C, Brosolo G, Zanette G, Michelli A, Ros RD. Nutritional supplementation on wound healing in diabetic foot: What is known and what is new? World J Diabetes 2022; 13:940-948. [PMID: 36437863 PMCID: PMC9693742 DOI: 10.4239/wjd.v13.i11.940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/13/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
Non-healing diabetic foot ulcers (DFU) are the most notable and striking complications of diabetes mellitus. More than 25% of nonhealing DFU can ultimately lead to amputation of the lower extremity within 6-18 mo after the first manifestation of the wound. Although wound healing is complex, nutritional status is crucial in soft tissue repair. Malnutrition is highly prevalent and overlooked in patients with diabetes and chronic wounds. Moreover, to date, we do not have clear recommendations or evidence about the use of nutritional supplements for improving wound healing in patients with DFU. In this article the authors briefly analyzed the current evidence on the use of nutritional supplements of proteins or amino acids, fatty acids, probiotics, vitamins, and trace elements in the wound healing process in patients with DFU.
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Affiliation(s)
- Andrea Da Porto
- Department on Internal Medicine, University of Udine, Udine 33100, Italy
| | - Cesare Miranda
- Department of Internal Medicine, Clinic of Endocrinology and Metabolism Diseases Azienda Sanitaria Friuli Occidentale, Pordenone 33170, Italy
| | - Gabriele Brosolo
- Department on Internal Medicine, University of Udine, Udine 33100, Italy
| | - Giorgio Zanette
- Department of Internal Medicine, Clinic of Endocrinology and Metabolism Diseases Azienda Sanitaria Friuli Occidentale, Pordenone 33170, Italy
| | - Andrea Michelli
- Department of Internal Medicine , SC Diabete e Centro Trattamento Piede Diabetico, Monfalcone 34074, Gorizia, Italy
| | - Roberto Da Ros
- Department of Internal Medicine , SC Diabete e Centro Trattamento Piede Diabetico, Monfalcone 34074, Gorizia, Italy
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